From the Research
The most common cause of massive bleeding in chronic pancreatitis is pseudoaneurysm (option a). Pseudoaneurysms develop when pancreatic enzymes leak and erode into adjacent arterial walls, weakening them and creating a blood-filled sac that communicates with the arterial lumen. In chronic pancreatitis, this typically affects the splenic, gastroduodenal, or pancreaticoduodenal arteries. The persistent inflammation and enzymatic activity in chronic pancreatitis gradually damage nearby blood vessel walls, leading to pseudoaneurysm formation. These pseudoaneurysms can rupture suddenly, causing life-threatening hemorrhage into the pancreatic duct (hemosuccus pancreaticus), gastrointestinal tract, peritoneal cavity, or retroperitoneum. Management typically involves urgent angiography with embolization or surgical intervention. While arteriovenous fistulas, mycotic aneurysms, and fibromuscular dysplasia can occur in the pancreatic region, they are much less common causes of massive bleeding in the specific context of chronic pancreatitis.
Key Points
- Pseudoaneurysms are the most common cause of massive bleeding in chronic pancreatitis, as reported in studies such as 1 and 2.
- The formation of pseudoaneurysms is due to the erosion of adjacent arterial walls by pancreatic enzymes, leading to the creation of a blood-filled sac that communicates with the arterial lumen.
- The splenic, gastroduodenal, and pancreaticoduodenal arteries are the most commonly affected vessels in chronic pancreatitis, as noted in 3 and 4.
- Management of pseudoaneurysms typically involves urgent angiography with embolization or surgical intervention, with embolization being a safe and effective treatment option, as shown in 5 and 2.
Treatment Options
- Angioembolization is a recommended treatment option for bleeding pseudoaneurysms in patients with chronic pancreatitis, with a high success rate and low morbidity and mortality rates, as reported in 2.
- Surgical intervention may be necessary in cases where embolization is not possible or has failed, with distal pancreatectomy and vessel ligation being potential surgical options, as noted in 1 and 2.